Dr Neil Paul

In this month’s column grassroots GP Dr Neil Paul outlines the five priorities for NHS IT that have been identified in his area.

My local ICT service is starting to develop a much better dialogue with primary care and we have identified five priorities for further work. Below – in no particular order – are those priorities and the progress that has been made on them so far.

Getting the IT working

I still hear far too many complaints about desktops not working on GPs’ desks. This sours the relationship that people have with the ICT department and stops them moving on to bigger projects.

Typical complaints include: “it takes too long to load in a morning, it crashes all the time, it constantly tries to patch and reboot in the middle of a surgery” and so on. The answer here is partly about making sure the kit on the desktop is up to the job it is meant to be doing.

It is also about having a customer facing helpdesk with well-trained people on it, who have experience of primary care and can understand the pressures on the people making calls to them. And it is about having support people who will look after a practice proactively and help to solve a problem to its end. Hopefully, all of these are coming in Cheshire – but we still have a way to go.

Getting more out of the telecommunications

We have been progressive and moved a lot of practices onto a primary care trust fixed link system, with VoIP phones and reliable networking, as well as the national N3 network. However, a lot of practices, often the more go-head ones, feel that they are not getting full use out of the kit.

They want call handling, queuing, and recording of calls and feel that modern, IT literate patients want all this too. People want their patients to be able to access their appointments and prescriptions out of hours. Some of this is available on the web, but there are telephone and text solutions that also need investigating. In theory, it makes more sense for a centralised organisation to do this than each practice re-invent the wheel itself.

As a PCT, therefore, we need to think whether the priority is to deliver to practices that want everything or to try to help the ones that are falling behind.

As a PCT, we haven’t always scored as well on access as we would have liked, so this is a big priority for the primary care team. We also need to think about the future of email, as (for historical reasons) half the practices are on NHSmail and most of the other half are on a PCT-hosted Exchange server.

Communications Secondary to Primary Care

We are in the middle of a big project in Cheshire that is installing Docman Electronic Document Transfer in all the practices across two PCTs. Hopefully, the three main hospitals – Chester, Leighton and Macclesfield – will feed electronically created discharge and outpatient information into it.

The aim is to ensure high quality, timely information with minimum administrative time or effort. Other providers can be added on later. Things are going well and trials are starting.

Communications Primary to Secondary Care

The hospitals have been superb and keen to implement this project. They have, however, asked “what about sending the information the other way, so that on admission or in outpatients, hospital staff can see up to date summary and prescribing information?”

In many ways, this is what the summary care record is all about – but no one is holding their breath for a national solution and we are investigating local, interim solutions. In Central Cheshire, some of the practices share data with the out-of-hours service using Graphnet, and I believe it is used to greater effect in West Cheshire. However, I don’t think it is a medium or long term solution.

So for the moment we are all watching EMIS Web with interest. The company seems to have sorted out the data transfer from LV and PCS and has agreements in place with Adastra and others. Locally, it looks like a particularly good choice for Leighton hospital, as most of its referring practices are EMIS.

The now separated provider arm is also looking to it as a possible appointments and clinical recording solution. So, potentially, it could work across the whole patch. One of the diabetes consultants is running a trial with a few practices to share summary data and transfer messages.

Education and Training

For some time I have felt that we could have more structured training rather than just IT support. At last it seems to be happening. Cheshire ICT is becoming a Microsoft training academy and is starting to offer all the usual courses, such as NHS Elite. But it is also offering basic, intermediate and advanced courses and even exam-based qualifications in all the individual components.

It will also be offering professional qualifications. Hopefully, this should mean that our IT support staff become better skilled – and it may even help with recruitment and retention. More needs to be done around non-Microsoft products, but hopefully, once we are all on a Windows platform, some of the skills are transferable.


Dr Paul is a GP in Sandbach, Cheshire and a member of the professional executive committee for Central and East Cheshire PCT and has a lead role for IM&T and practice based commissioning. A version of this article first appeared on the Microsoft NHS Resource Centre.